Cited by 538Nutritional Studies and DietFood composition and propertiesCardiovascular Health and Risk Factors

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Associations of whole-grain, refined-grain, and fruit and vegetable consumption with risks of all-cause mortality and incident coronary artery disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study

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Steffen, Lyn M, Jacobs, David R, Stevens, June, Shahar, Eyal, Carithers, Teresa, Folsom, Aaron R·2003·The American Journal of Clinical Nutrition

DOI 10.1093/ajcn/78.3.383

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Abstract

Background Recent epidemiologic study results showed that subjects who had high intakes of whole-grain foods had lower risks of death and heart disease than did subjects who had low intakes. However, the findings were inconsistent for fruit and vegetable intake. Objective The relations of whole-grain, refined-grain, and fruit and vegetable intakes with the risk of total mortality and the incidence of coronary artery disease (CAD) and ischemic stroke were studied in the Atherosclerosis Risk in Communities (ARIC) cohort (baseline: age 45-64 y, n = 15,792). Design Proportional hazards regression analyses were used to assess the relations of whole-grain, refined-grain, and fruit and vegetable intakes with the risk of death and the incidence of CAD and ischemic stroke, with adjustment for age, sex, ethnicity, energy intake, and cardiovascular disease risk factors. Dietary intakes were assessed by using a food-frequency questionnaire. Results Over an 11-y follow-up period, whole-grain intake was inversely associated with total mortality and incident CAD. The relative hazards of death for quintiles 2-5 of fruit and vegetable intake were 1.08 (95% CI: 0.88, 1.33), 0.94 (0.75, 1.17), 0.87 (0.68, 1.10), and 0.78 (0.61, 1.01), respectively; P for trend = 0.02. An inverse association between fruit and vegetable intake and CAD was observed among African Americans but not among whites (P for interaction = 0.01). The risk of ischemic stroke was not significantly related to whole-grain, refined-grain, or fruit and vegetable consumption. Conclusion These observational findings suggest a beneficial effect of whole-grain and fruit and vegetable consumption on the risks of total mortality and incident CAD but not on the risk of ischemic stroke.

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Background

Authors: Steffen, L. M., Jacobs, D. R., Stevens, J., Shahar, E., Carithers, T., & Folsom, A. R.
Affiliations: University of North Carolina at Chapel Hill (US)
Corresponding author: Steffen, Lyn M
ORCID: Steffen, Lyn M
Jacobs, David R
Shahar, Eyal
Carithers, Teresa
Folsom, Aaron R
Venue: The American Journal of Clinical Nutrition
Publisher: Elsevier BV
Published: 2003-09
Volume: 78
Issue: 3
Pages: 383-390
ISSN: 0002-9165 (ISSN-L)
DOI: 10.1093/ajcn/78.3.383
OpenAlex: W2100700568
Cited by: 538
References: 34
Citations by year: 2026: 3 · 2025: 6 · 2024: 11 · 2023: 13 · 2022: 24 · 2021: 25 · 2020: 19 · 2019: 14 · 2018: 12 · 2017: 22 · 2016: 30 · 2015: 29 · 2014: 33 · 2013: 36 · 2012: 35
FWCI: 22.77
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 7109 d)
Locations: American Journal of Clinical Nutrition (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (n01hc55021-47-0-1, n01hc55020-39-0-0, n01hc55016-37-0-0, n01hc055022-024, n01hc55019-35-0-1, n01hc55018-38-0-1, n01hc55015-48-0-1)
National Heart, Lung, and Blood Institute (N01-HC55022, N01-HC-55018, N01 HC 55020, N01 HC 55019, N01-HC55016, N01‐HC‐55015, N01-HC55021)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords: whole grain intake, fruit and vegetable intake, all-cause mortality, coronary artery disease, ischemic stroke, dietary intake, African Americans, cardiovascular risk
MeSH terms: Arteriosclerosis, Edible Grain, Coronary Artery Disease, Diet, Female, Follow-Up Studies, Fruit, Humans, Male, Surveys and Questionnaires, Risk, Vegetables, Cohort Studies, Incidence, Proportional Hazards Models, Stroke

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Associations of whole-grain, refined-grain, and fruit and vegetable consumption with risks of all-cause mortality and incident coronary artery disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study

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